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Biomedical subjects

K Kellner

Publications and source records attributed to K Kellner.

At least 19 recordsLinked to original sources
PubMed1992

Combined high-efficiency hemodialysis and charcoal hemoperfusion in severe N-acetylprocainamide intoxication.

Several extracorporeal techniques have been used to remove N-acetylprocainamide (NAPA), the major metabolite of procainamide, in patients intoxicated with this substance. We report a patient with life-threatening NAPA intoxication who was rapidly and successfully treated with combined high-efficiency hemodialysis and charcoal hemoperfusion. The hemodialyzer and hemoperfusion cartridge were placed in series such that the patient's blood was dialyzed before reaching the cartridge. Overall clearance of NAPA was 153 mL/min, with clearance due to hemodialysis averaging 102 mL/min and that due to hemoperfusion averaging 88 mL/min. Thus, addition of the hemoperfusion cartridge into the extracorporeal circuit resulted in a 50% increase in clearance over that obtainable by high-efficiency hemodialysis alone. In comparison to other modalities, this technique is more effective than either hemodialysis or charcoal hemoperfusion alone and can achieve a more rapid reduction of serum NAPA levels than that observed with slow continuous hemofiltration or hemodiafiltration.

Acecainide↗
PubMed1990

[The effect of verapamil on adrenocortical hormone secretion].

Variations in circadian cortisol rhythm, morning ACTH concentration and the 24-hour cortisol excretion were examined in 15 healthy volunteers and 9 untreated patients with cardiovascular diseases. These variations were measured under basal conditions and during low dose (ACTHL-test) and also a high dose (ACTHH-test) ACTH stimulation. Additionally, in the patients with cardiovascular diseases the effect of verapamil-administration was investigated. Under basal conditions no significant differences were to be seen between normal subjects and the patients, either before or after therapy. The two functional tests resulted in almost identical increases of cortisol and ACTH levels, both in healthy subjects and the patients before verapamil. It was found that after verapamil application during the ACTHL-test, the levels of plasma cortisol decreased in comparison with the values noted before verapamil (p less than 0.05). However, in the ACTHH-test a significant increase of the plasma cortisol (p less than 0.05) was evident. Our results lead to the conclusion that after verapamil therapy, under slight loading, the plasma cortisol concentration can be expected to decrease slightly, and in extremely high stress situations it will increase.

Adrenocorticotropic Hormone↗
PubMed1990

[Does the calcium antagonist verapamil modify calcium metabolism?].

In 11 healthy volunteers the effects of oral verapamil administration (4 X 80 mg/d) on plasma or serum concentrations of ionized, pH-corrected ionized and total calcium, on intact and midregional parathyroid hormone and on 24 h urinary excretion of calcium were investigated at rest. In addition the concentrations of ionized, pH-corrected ionized and total serum calcium were analyzed under bicycle exercise. Verapamil resulted in an increase of total serum calcium (p less than 0.02) and a fall in midregional parathyroid hormone concentrations (p less than 0.02) at rest. There was also found a statistically significant elevation of both ionized (p less than 0.05) and pH-corrected ionized (p less than 0.05) plasma calcium, and a slight increase in the total calcium under exercise (p less than 0.1). Before verapamil a significant negative correlation between total calcium and midregional parathyroid hormone was evident (r = -0.618; p less than 0.05), which however could not be clearly discerned after verapamil.

Adult↗
PubMed1989

[Verapamil in primary hyperparathyroidism].

In a female patient with primary hyperparathyroidism and disturbances of cardiovascular function clinical, biochemical and electrocardiographic as well as bone scintigraphic parameters were analyzed before and during therapy with verapamil (Falicard) for 7 month. Verapamil therapy resulted in decrease of the frequency of the supraventricular tachycardia, and, in higher doses (4 X 120 mg), also reduction of blood pressure, however, with dose limiting bradycardia and prolongation of PQ-time. Both the normalization of serum phosphate level, diminution of hypercalcemia of the ionized calcium and the decrease of hypercalciuria and increase of scintigraphic index as an expression of the decrease of high activity of bone metabolism suggest alterations of the calcium homeostasis. Under oral calcium load the constantly increased PTH values markedly could be suppressed indicating an alteration of intracellular parathyroid calcium set point. Discussion is performed with respect to possible protective metabolic and cardiovascular effects of calcium antagonists in this endocrine functional disorder.

Adult↗
PubMed1989

[Hormone changes as indicators of stress in the development and course of myocardial infarct].

The effect of hormonal-metabolic risk factors in the development of various forms of the coronary heart disease is included into a concept of stress. After demonstration of the historical development of the stress research on the further developed basis of the general adaptation syndrome of Selye the adrenocortical system is used for the evaluation of stressors. Thereby the hormonal characteristics of the behaviour of type A which is at risk of an infarction after Friedman and Rosenman are described. The hormonal-metabolic adaptation of the organism to psychosomatic stressors is demonstrated for the acute phase and the chronic phase. In the acute phase the corticol level correlates with the clinical course of the infarction as well as with the haemodynamic parameters PAEDP and heart index. Cortisol is regarded as parameter of the postaggression metabolism. The increased cortisol level dependent upon time in its course leads to the low-T3-syndrome and to the decrease of testosterone. From this result secondarily effective modifications of the metabolism which are above all valuated as defence reactions. In the chronic phase of risk the values of cortisol are lowered in the stress response. This low cortisol response is a functional maladaptation, which according to our retrospective study is prognostically favourable. A therapeutic influence on the adrenocortical function by calcium antagonists is effective, but up to now not yet sufficiently proved.

Adrenocorticotropic Hormone↗
PubMed1989

[Hyperthyroidism and its relation to heart function].

The influence of hyperthyreosis on the cardiac function was investigated by means of non-invasive methods (radiocardiography, echocardiography, Tc-99m- und Tl-201-scintigraphy of the myocardium) and invasive methods (coronary angiography). Independent of age an increase of the frequency was always existing, a significant increase of the filling of the ventricle, of SI and HI was shown only by younger patients. With the help of the echocardiography local and global disturbances of kinetics, by means of the Tl-201-scintigraphy of the myocardium disturbances of the myocardial perfusion could be proved. For the circulating plasma catecholamines noradrenalin, adrenalin and dopamine values were established lying in the lower region of the normal. The effects of an increase of the thyroid hormone on the number and/or sensitivity of the membrane-bound beta-adrenoceptors of the heart as well as the independent of its effect of the SDH on the obtaining of myocardial energy are discussed.

Adolescent↗
PubMed1985

[Gonadal and adrenocortical hormone changes in myocardial infarct].

On a male group of patients investigations of the behaviour of the testosterone, LH, cortisol and ACTH serum concentrations in the hospital phase of the acute myocardial infarction were carried out. Apart from an early activation of the adreno-cortico-pituitary axis a decrease of the testosterone concentrations at consistent LH levels was observed. On healthy test persons in the ACTH and hydrocortisone tolerance test possible interactions between adrenocortical and gonadal hormone system were controlled.

Adrenocorticotropic Hormone↗
PubMed1985

[Radioimmunologic determination of serum testosterone concentration in healthy male probands].

By means of the test set Testosterone-RIA SSW age-depending areas within the normal of the total hormone level of testosterone in the serum was established in 122 healthy male test persons. The examination resulted in an increase of the testosterone concentration from the 20th to the 55th year of age and a following exponential decrease. The exactness of the intraassay lies in the mean region of concentration at 8-12% and the exactness of the interassay between 10-20%. The sensitivity of the determination is 2.7 +/- 1.8 nmol testosterone/l.

Adult↗
PubMed1984

[Behavior of ACTH and cortisol in acute myocardial infarct].

In 30 patients with acute myocardial infarction in 4-hour intervals the temporary course of the ACTH and cortisol in the plasma was pursued up to the 60th hour. Here 3 different patterns of behaviour were found. In group 1 (11 patients) normal ACTH and cortisol values are present during the period of examination. In group 2 (13 patients) ACTH in increased at admission to hospital, and a decrease of the values to the normal takes place after the beginning of the infarction within 4 to 8 hours, whereas the plasma cortisol remains clearly increased. Increased ACTH and cortisol values during the whole period were measured in group 3 (6 patients). The different hormone constellations found are possibly the expression of a different reaction behaviour of the adrenocortical system in acute myocardial infarction. There is a weak positive correlation between the creatine kinase and the plasma cortisol. The size and the duration of the increase of ACTH and cortisol seems to be connected with the degree of severity of the acute myocardial infarction. An increase of ACTH and cortisol for a longer time is to be regarded as unfavourable for the course of the acute myocardial infarction, while uncomplicated courses are connected with normal ACTH and cortisol in the plasma.

Adrenocorticotropic Hormone↗
PubMed1984

[Occupational and social rehabilitation of patients in an operative-traumatologic intensive care unit].

About 100 polytraumatized patients were treated yearly at the ICU of the Institute of Anaesthesiology of the Technical University of Munich. Mortality lay in the range between 30 to 40%, i.e. approximately 70 patients had to be rehabilitated per year. 75 patients treated from 1976 to 1977 were followed-up and their condition was investigated together with an inquiry into their work readjustment and social rehabilitation. In most cases the patients were found to be able to resume their previous work and it was possible to reintegrate them into society and their families. With the exception of 2 patients all examined patients still suffered some disablement.

Abdominal Injuries↗
PubMed1984

[Experiences and impressions of patients in an surgical-trauma intensive care unit].

Within the framework of a retrospective study performed by the Department of Anaesthesiology at Munich Technical University, 150 polytraumatized patients admitted to the intensive-care unit between 1976 and 1978 were questioned as to experiences and general impressions during their stay in the unit. The data obtained in this manner were recorded and systematically analysed. The average period of time between initial treatment and follow-up examination was 5 years. Average length of admission to the intensive-care unit was 20 days and the average age at time of injury was 27 years; 73% of the patients were artificially ventilated for approximately 7 days; 94 patients (63%) had cranio-cerebral trauma. A marked sense of security as well as strong emotional attachment to the ICU personnel were the most prevalent impressions obtained on questioning; these impressions were shared by almost all of the patients within the study. Reports of experience of anxiety were the exception. The presence of other patients within the same room, as well as the resulting opportunity to communicate with these patients, was psychologically supportive and provided a feeling of solidarity. Among the most prevalent of the negative impressions was a feeling of extreme thirst reported by 40 of the patients interviewed. Detrimental effects mentioned in many of the other investigations of intensive care patients such as loss of ability to communicate, lack of orientation as well as abolition of circadian rhythm played only a minor role in our study.

Adaptation, Psychological↗
PubMed1980

[Behavior of thyroid hormones, corticosterone, adrenocorticotropic hormone and insulin in the plasma of the rat under stress conditions].

In male Wistar rats the behaviour of the plasma concentrations of thyroid hormones, corticosterone, adrenocorticotrophic hormone and insulin was examined in the course of a hypokinase stress of 6 weeks duration. Blood was taken after a stress of 1, 3 and 6 weeks. In these cases in thyroid hormones a decrease of the thyroxine (T4) and an increase of the triiodothyronine (T3) appeared. In an increased need of energy of the organism apparently a more rapid peripheral conversion of T4 to the more active metabolic T3 takes place. Only after a longer stress the deficit of thyroid hormone is equalized via the regulating circle hypothalamus-hypophysis-thyroid gland. The hormones ACTH and corticosterone which are connected together in the regulation system hypothalamus-hypophysis-adrenal cortex, after one week slightly increase in the plasma of rats and clearly decrease after a stress of 3 weeks. This shows that in a longer stress load apparently an exhaustion of the bioenergetic reserves of the organism develops. At last under long-term stress a significant decrease of the plasma insulin level was found. The decrease of insulin might be conditioned by an endogenic liberation of catecholamine.

Adrenocorticotropic Hormone↗
PubMed1980

[Modification of thyroid hormones by unsaturated fatty acid after noradrenaline load].

In 13 patients with a hyperlipoproteinaemia of type IIa under a diet fat-modified and rich in linoic acid which contained only few animal fats and cholesterol the long-term behaviour of T3 and T4 was determined. After 7 months significant reductions of the T3- as well as increases of the T4-concentrations in the blood were found, in which cases the physiological regions were neither transgressed nor subgressed. These results correspond to the results given in literature, established, however, in animal experiments. Possible mechanisms of action are discussed, in which cases above all peripheral sites of action by influence on the fluidity and function of cell membranes and cell organelle membranes might be taken into consideration. This assumption could also be supported by the results of pharmacological stress loads.

Adult↗
PubMed1980

[Effect of noradrenergic stimulation on the peripheral venous concentrations of thyroxine and triiodothyronine in young test subjects with normal metabolism].

The influence of intravenous noradrenalin infusions in increasing dosages lasting 60 minutes on the peripheral venous total T3- and total T4-concentrations of blood, blood pressure and heart rate was established on 5 test persons during a period of 110 minutes. Immediately after the addition of 0.12 micrograms NA/kg Kgw./min an increasing tendency of the T4-concentration in the venous blood occurred, respectively. Under influence of higher NA-doses (0.20 and 0.33 micrograms/kg Kgw./min) the noradrenergically induced T4-increase (p < 0.05) with average increases of the T4-level by 28.7 and 22.3%, respectively, in comparison to the initial values was statistically secured. The total T3-concentration did not show any statistically secure changes under NA-infusion. The fundamental possibilities of an influence of the intravenously applied NA on the production of the hormone of the thyroid gland, the secretion of the thyroid hormone and the peripheral conversion are discussed. Using findings of animal experiments the supposition of the immediate influence of the NA on the follicle cells of the thyroid gland and the secretory process gains importance. The clinical importance of the adrenergic modulation of the thyroxin secretion for the clinician is discussed.

Adult↗
PubMed1980

[Thyroid hormones, cholesterol, erythrocyte aggregation and fibrinogen degradation products in acute myocardial infarct].

One hundred and sixty-two patients with acute myocardial infarction, whose ages ranged from 36 to 65, were studied. The content of thyroid hormones was found to be reduced in the acute period of myocardial infarction. The triiodothyronine level was lower on the 2nd day of the disease, the thyroxine content decreased on the 10th day of the disease but became normal on the 20-25th day. An interrelation between the clinical course of the disease and the dynamics of changes in the cholesterol content, rate of erythrocyte aggregation, the content of fibrinogen degradation products, and the level of thyroid hormones was determined. Normalization of the values was determined. Normalization of the values studied occurred earlier in the group of patients with a more favourable course of the acute period of myocardial infarction than in those with severe myocardial infarction. The data obtained show a close interrelation between thyroid activity and values studied and the clinical course of the disease.

Adult↗